[Epidemiology and prophylaxis of hospital infections in obstetric and pediatric hospitals]. / Epidemiologiia i profilaktika vnutribol'nichnykh infektsii v akusherskikh i pediatricheskikh statsionarakh.

The analysis of reports of the obstetric and pediatric hospitals of Moscow for 1991-1998 revealed that, simultaneously with the deterioration of the quality of life of the population, not only a decrease in the birth rate, but also a rise in different forms of pathology in pregnant women and puerperae could be observed. The deterioration of the health characteristics of mothers was accompanied by the growth of high risk groups among newborns as well. Thus, the number of children, born sick or falling sick while staying in the obstetric clinics of Moscow, rose from 208 to 299 o/oo. Simultaneously with the growth of somatic pathology, a significant rise in infectious morbidity rate among newborns from 15 to 43 o/oo and a rise in death rate among newborns due to infectious pathology were noted. A complex of prophylactic measures is proposed. Their introduction will make it possible to decrease the probability of the appearance of severe forms of pathology in pregnant women and newborns, to ensure the effectiveness of epidemiological surveillance of hospital infections and to prevent their further growth among puerperae and newborns.

[The prevention of hospital infections in newborns and puerperae today]. / Profilaktika vnutrobol'nichnykh infektsii u novorozhdennykh i rodil'nits na sovremennom étape.

The analysis of reports of from maternity clinics and children's hospitals in the Russian Federation for the period of 1986-1994 showed that simultaneously with deterioration of the quality of life of the population not only a drop in the birth rate was registered, but also a significant increase in the appearance of different forms of pathology in pregnant and parturient women occurred. The deterioration of the characteristics of maternal health was accompanied by an increase in the number of high risk groups also among newborns. Thus, in the maternity clinics of the Russian Federation the number of children born sick or becoming sick shortly after birth rose 2.5-fold. Simultaneously with an increase in somatic pathology there was a significant rise in the number of cases of generalized infection among parturient women form 0.3 to 1.2%/1000, and cases of infections diseases among newborns from 10.4 to 21.5%/1000, as well as in infant mortality due to infections pathology. A complex of prophylactic measures is proposed; the realization of theses measures will make it possible to decrease the probability of the development of new severe forms of pathology in pregnant women and newborns, as well as to ensure effective epidemiological surveillance on hospital infections and to prevent their further rise among parturient women and newborns.

[Bacteriotherapy of intestinal dysbacteriosis in patients with acute leukemia]. / Bakterioterapiia disbakterioza kishechnika u bol'nykh ostrymi leikozami.

The results have been presented of correcting intestinal microflora in 127 patients with acute leukemia by preparations containing Bacillus bifidus and acidophilus: dried and milk bifidum-bacterin, biofructolact, acidophilic milk.

[Detection of antibodies to the causative agents of viral infections in multiple sclerosis patients]. / Obnaruzhenie antitel k vozbuditeliam nekotorykh virusnykh infektsii u bol'nykh rasseiannym sklerozom.

Serological examinations of blood sera from patients with multiple sclerosis (MS), their nearest relatives, and subjects of the control groups for antibodies to causative agents of some viral infections demonstrated antihemagglutinins to measles and rubella viruses in 61%-95.5% of the subjects examined in all the groups, to mumps virus in 53% in MS patients, to tick-borne encephalitis virus in 2.2% in the same group, and in 10.5% in the group of patients with other CNS diseases, and none in healthy subjects. Virus-neutralizing antibodies to human acute encephalomyelitis virus (HAEM) in 28% of the cases, frequently in the stage of remission. Specific IgM to measles virus was found in 41% of MS patients, in 15% of their nearest relatives, and in 19.7% of patients with other CNS diseases, but not in healthy subjects. No differences in the rate of antibody findings to herpes simplex virus types 1 and 2 were observed in the groups examined. The rate of detection of virus-neutralizing antibody to HAEM virus was significantly higher in MS patients with the severity of the course of IV-V degree (20%) than of the II-III degree (8.8%). In the period of MS exacerbation the level of specific IgM to measles virus increased (35.6%), and higher titres of antihemagglutinins were observed in patients with longer duration of the disease and higher degree of its severity.

Analysis of epidemiological peculiarities of rubella based on a mathematical model (according to observations over 10 years in Moscow).

The main epidemiological values characterizing rubella in Moscow were calculated on the basis of a new mathematical model. Quantitative estimates of the intensity of infection in different age groups of the population were obtained. It has been established that the risk of infection in children is especially high in comparison with adult population. That is why 98% of the population aged 15 are immune. The probability of falling ill with rubella was determined for persons with different antibody levels. The cases of congenital rubella in Moscow are rare due to the low risk of infection in adults and to their immunity acquired in childhood. Consequently, there is no necessity for vaccination against rubella in Moscow at the present time, but it should be recommended to organize constant epidemiological surveillance of congenital rubella.

[Acute meningoencephalitis and the problem of viral persistence in complicated rubella]. / Ostrye meningoéntsefality i problema persistentsii virusa pri oslozhnennoi krasnukhe.

The results of combined clinico-virological and immunological examinations of 25 children with rubellar meningoencephalitis are presented. The meningoencephalitis was preceded by typical rubella in 24, and by rubellar infection without eruptions in 1 child. In 6 children the rubella virus was isolated from the cerebrospinal fluid in the acute period of the disease (5th to 19th days), and in 2 children it was re-isolated on the acute period of the disease (5th to 19th days), and in 2 children it was re-isolated on the 17th-19th days. A persistence of the immunoglobulins M specific to the rubella virus was revealed both in the acute period of the disease and long time after the disease onset (the observation period was 409 days). The data obtained confirm the etiological role of the rubella virus in the development of rubellar meningoencephalitis, suggesting that the rubella virus may persist in complicated post-natal rubella.

[Use of a combined epidemiological, virological and morphological analysis of rubella infection for an epidemiological survey of congenital rubella]. / Primenenie kompleksnogo épidemiologicheskogo i virusologo-morfologicheskogo analiza krasnushknoi infektsii v tseliakh épidemiologicheskogo nadzora za vrozhdennoi krasnukhoi.

The results of composite epidemiological, virological and morphological studies of intrauterine rubella infection performed in 1979, in the period of maximum increase of rubella incidence in Moscow for 11 years (1969-1979) are presented. Investigations of 125 foci of rubella established a relatively high frequency of contacts of pregnant women with the source of infection in families of rubella patients. Twenty-nine cases of clinically manifest and inapparent rubella among pregnant women were detected and confirmed in the laboratory; intrauterine infection at 3-17 weeks was established in 16 out of 18 virologically examined women. The ratio of the disease forms was 3.5 : 1. Using laboratory methods of investigations, rubella of pregnant women was confirmed in 100% cases. From the aborted and fetal materials collected in the disease or inapparent infections of pregnant women rubella virus was isolated in 88.9%, marked pathomorphological lesions were found in organs of 61% of the fetuses examined. The organotropism of rubella virus was confirmed by a high rate (87%) of virus isolation from placenta and umbilical cords as well as by localization of morphological lesions in these organs and in the eye lens tissues. These characteristics of marked teratogenic potentials of the circulating virus strains indicate the necessity of organization of regular epidemiological surveys of rubella in pregnant women for prevention of congenital rubella in the USSR.

Congenital rubella in the USSR.

The results of a comprehensive study of the problem of congenital rubella in Moscow and other cities of the USSR are presented. The highest rubella incidence was found among children 1-7 years of age; but 20-25 rubella cases were also recorded annually per 100 000 adults. Specific antihaemagglutinins were found in 36-70% of children and in 91-99% of adults. Investigation of the rubella foci revealed clinical rubella, confirmed by laboratory methods, in children and adults who had low initial titres of specific antihaemagglutinins. Serological screening of 1661 apparently healthy pregnant women detected antihaemagglutinins in 98.4%; however, low (1:8-1:16) titres were found in 53.3% and high (postinfection) titres and specific IgM in only 8.8% of cases.A study of 523 pregnant women who had been in contact with a source of infection revealed clinical rubella in 10.9% and inapparent infection in 0.7% of cases. A virological study of fetuses from infected pregnant women showed that there was intrauterine viral infection in 73% of cases; 38% of rubella-infected fetuses had congenital defects (unilateral or bilateral cataract, absence of one cerebral hemisphere, adhesion of the upper and lower eyelid, or diffuse damage of the crystalline lens); in one woman rubella virus was isolated from the fetuses and abortion materials received from two abortions with an interval of 6 months. Serological investigation of 519 mothers who had given birth to children with congenital defects showed that there were more frequent indications of rubella infection in the mothers of the children with CNS and cardiovascular defects, as well as in the children with congenital cardiovascular and CNS defects, than in the control groups. These data confirmed the teratogenic nature of rubella strains found in the USSR. This study indicates the need to improve rubella surveillance in pregnant women and to consider the prophylaxis of congenital rubella in the USSR. (See also Addendum.)